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https://www.readbyqxmd.com/read/28641753/cardiac-dysfunction-in-congenital-diaphragmatic-hernia-pathophysiology-clinical-assessment-and-management
#1
Neil Patel, Florian Kipfmueller
Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery...
June 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28640039/levosimendan-prevents-and-reverts-right-ventricular-failure-in-experimental-pulmonary-arterial-hypertension
#2
Mona Sahlholdt Hansen, Asger Andersen, Sarah Holmboe, Jacob Gammelgaard Schultz, Steffen Ringgaard, Ulf Simonsen, Chris Happé, Harm Jan Bogaard, Jens Erik Nielsen-Kudsk
BACKGROUND: We investigated whether chronic levosimendan treatment can prevent and revert right ventricular (RV) failure and attenuate pulmonary vascular remodelling in a rat model of pulmonary arterial hypertension (PAH). METHODS AND RESULTS: PAH was induced in rats by exposure to SU5416 and hypoxia (SuHx). The rats were randomized to levosimendan (3 mg/kg/day) initiated before SuHx (n=10, PREV), levosimendan started 6 weeks after SuHx (n=12, REV), or vehicle treatment (n=10, VEH)...
June 19, 2017: Journal of Cardiovascular Pharmacology
https://www.readbyqxmd.com/read/28631764/-hemodynamic-effects-of-positive-end-expiratory-pressure
#3
Marco Marini, Giorgio Caretta, Fabio Vagnarelli, Fabiana Lucà, Emilia Biscottini, Alberto Lavorgna, Vincenza Procaccini, Letizia Riva, Gabriele Vianello, Nadia Aspromonte, Andrea Mortara, Renata De Maria, Piera Capasso, Serafina Valente, Michele Massimo Gulizia
The application of a positive end-expiratory pressure (PEEP), the cornerstone of noninvasive ventilation (NIV), causes hemodynamic changes in the cardiovascular system. To understand the benefits of NIV it is necessary to resume concepts of cardiovascular physiology and pathophysiology about cardiac function determinants, venous return, ventricular interdependence and heart-lung interaction, and to understand how PEEP interacts with them. The hemodynamic effects of PEEP are mediated by the increase in transpulmonary pressure, which results in increased pulmonary vascular resistance and in an attending small reduction of venous return in conditions of euvolemia, in a substantial reduction of left ventricular afterload and a potential positive effect on left ventricular stroke volume...
June 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28623932/impact-of-glycemic-control-on-aortic-stiffness-left-ventricular-mass-and-diastolic-longitudinal-function-in-type-2-diabetes-mellitus
#4
Michaela Kozakova, Carmela Morizzo, Alan G Fraser, Carlo Palombo
BACKGROUND: Poor glycemic control is associated with impaired left ventricular (LV) diastolic function in patients with type 2 diabetes mellitus (T2DM). Inappropriate LV mass increase and accelerated aortic stiffening were suggested to participate on deterioration of diastolic function. The present study investigated the inter-relationships between glycemic control, early diastolic and systolic longitudinal velocity of mitral annulus, LV mass and aortic stiffness in T2DM patients free of cardiovascular disease and with preserved LV ejection fraction, and compared them with those observed in healthy volunteers of similar age and sex distribution...
June 17, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28604468/point-of-care-ultrasonography-to-assess-portal-vein-pulsatility-and-the-effect-of-inhaled-milrinone-and-epoprostenol-in-severe-right-ventricular-failure-a-report-of-2-cases
#5
Jan-Alexis Tremblay, William Beaubien-Souligny, Mahsa Elmi-Sarabi, Georges Desjardins, André Y Denault
This article describes 2 patients with severe acute right ventricular failure causing circulatory shock. Portal vein pulsatility assessed by bedside ultrasonography suggested clinically relevant venous congestion. Management included cardiac preload reduction and combined inhalation of milrinone and epoprostenol to reduce right ventricular afterload. Portal vein ultrasonography may be useful in assessing right ventricular function in the acutely ill patient.
June 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28603624/predicting-the-need-for-fluid-therapy-does-fluid-responsiveness-work
#6
REVIEW
Hiroshi Ueyama, Sawami Kiyonaka
Fluid overdose can be harmful in critically ill patients. Since central venous pressure (CVP) is currently considered to be an inappropriate indicator of preload, much attention is being given to predicting fluid responsiveness, i.e., the response of stroke volume (SV) or cardiac output (CO) to fluid challenge. However, when fluid responsiveness was evaluated in critically ill patients, including sepsis, only 40-50% of the patients responded. Moreover, most fluid responders do not show significant hemodynamic improvement after fluid administration...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28597767/increased-mortality-from-complications-of-pulmonary-hypertension-in-patients-undergoing-transcatheter-aortic-valve-replacement
#7
Raj Parikh, Benson Varghese, Huma N Khatoon, Julie A Kovach, Clifford J Kavinsky, Rajive Tandon
Aortic stenosis (AS) leads to pulmonary hypertension (PH) and right ventricle (RV) failure. Our goal was to describe mortality related to postoperative complications in PH patients undergoing transcatheter aortic valve replacement (TAVR). Ninety-three TAVR patients were analyzed (controls, sPAP < 50 mmHg; cases, sPAP ≥ 50 mmHg). Significant findings in cases included increased mortality (365 days), post-TAVR atrioventricular block (AVB) and acute kidney injury (AKI), and increased mean length of stay (LOS)...
April 2017: Pulmonary Circulation
https://www.readbyqxmd.com/read/28592415/role-of-stim1-in-hypertrophy-related-contractile-dysfunction
#8
Constantine D Troupes, Markus Wallner, Giulia Borghetti, Chen Zhang, Sadia Mohsin, Dirk von Lewinski, Remus M Berretta, Hajime Kubo, Xiongwen Chen, Jonathan Soboloff, Steven R Houser
Rationale: Pathological increases in cardiac afterload result in myocyte hypertrophy with changes in myocyte electrical and mechanical phenotype. Remodeling of contractile and signaling Ca(2+) occurs in pathological hypertrophy and is central to myocyte remodeling. Stromal Interaction Molecule 1 (STIM1) regulates Ca(2+) signaling in many cell types by sensing low endoplasmic reticular Ca(2+) levels and then coupling to plasma membrane Orai channels to induce a Ca(2+) influx pathway. Previous reports suggest that STIM1 may play a role in cardiac hypertrophy but its role in electrical and mechanical phenotypic alterations are not well understood...
June 7, 2017: Circulation Research
https://www.readbyqxmd.com/read/28591467/the-effect-of-impella-cp-on-cardiopulmonary-physiology-during-venoarterial-extracorporeal-membrane-oxygenation-support
#9
Hoong Sern Lim
Left ventricle (LV) distension is a complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The effects of Impella on the pulmonary circulatory physiology were studied in a single-center study of six consecutive patients on VA-ECMO support who had LV unloading with Impella. Right ventricular stroke volume, pulmonary hemodynamics, and partial pressure of end-tidal CO2 (PETCO2 ) were measured on echocardiogram, pulmonary artery catheter, and capnography, respectively. The addition of Impella CP increased total blood flow and reduced pulmonary artery wedge pressure...
June 7, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28576644/real-time-electromagnetic-tracking-based-treatment-platform-for-high-dose-rate-prostate-brachytherapy-clinical-workflows-and-end-to-end-validation
#10
Luc Beaulieu, Emmanuel Racine, Dae Yup Han, Eric Vigneault, I-Chow Hsu, J Adam M Cunha
PURPOSE: New technologies were integrated into a novel treatment platform combining electromagnetically (EM) tracked catheters, a 3D ultrasound (3DUS) imaging device, and a new treatment planning system to provide a real-time prostate high-dose-rate (HDR) brachytherapy treatment system. This work defines workflows for offline CT and online 3DUS planning scenarios and preclinical end-to-end validation of the platform. METHODS AND MATERIALS: The platform is composed of an EM-tracked stylet, a EM-tracked 3DUS probe, and an EM-tracked template guide, all used with the NDI Aurora field generator (NDI, Ontario, Canada)...
May 30, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28574276/intra-aortic-balloon-pump-protects-against-hydrostatic-pulmonary-oedema-during-peripheral-venoarterial-extracorporeal-membrane-oxygenation
#11
Nicolas Bréchot, Pierre Demondion, Francesca Santi, Guillaume Lebreton, Tai Pham, Apostolos Dalakidis, Laetitia Gambotti, Charles-Edouard Luyt, Matthieu Schmidt, Guillaume Hekimian, Philippe Cluzel, Jean Chastre, Pascal Leprince, Alain Combes
BACKGROUND: Increased left ventricular afterload during peripheral venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support frequently causes hydrostatic pulmonary oedema. Because physiological studies demonstrated left ventricular afterload decrease during VA-ECMO assistance combined with the intra-aortic balloon pump (IABP), we progressively changed our standard practice systematically to associate an IABP with VA-ECMO. This study aimed to evaluate IABP efficacy in preventing pulmonary oedema in VA-ECMO-assisted patients...
June 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28572979/complex-effects-of-high-flow-nasal-cannula-therapy-on-hemodynamics-in-the-pediatric-patient-after-cardiac-surgery
#12
EDITORIAL
Yu Inata, Muneyuki Takeuchi
BACKGROUND: The high-flow nasal cannula (HFNC) system has been widely used for children in various clinical settings. However, the physiological and clinical impact of HFNC therapy on the pediatric patient with respiratory distress after cardiac surgery has not been thoroughly investigated. MAIN BODY OF THE ABSTRACT: It seems logical to use HFNC as a primary therapy for post-extubation respiratory failure after congenital heart surgery, in which low cardiac output syndrome and upper airway obstruction are commonly encountered; the HFNC therapy alleviates the work of breathing and large negative swings of intrathoracic pressure, which in turn helps to decrease the systemic ventricular afterload...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28572119/right-ventricular-dyssynchrony-and-exercise-capacity-in-idiopathic-pulmonary-arterial-hypertension
#13
Roberto Badagliacca, Silvia Papa, Gabriele Valli, Beatrice Pezzuto, Roberto Poscia, Manuela Reali, Giovanna Manzi, Elisa Giannetta, Daniele Berardi, Susanna Sciomer, Paolo Palange, Francesco Fedele, Robert Naeije, Carmine Dario Vizza
Survival in patients with pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to afterload. How altered RV function impacts on exercise capacity in PAH is not exactly known.104 idiopathic PAH (IPAH) patients aged 52±14 years underwent a diagnostic right heart catheterisation, a comprehensive echocardiography including two-dimensional speckle tracking for RV dyssynchrony evaluation and a cardiopulmonary exercise test. Multivariate analyses were performed to identify independent predictors of peak oxygen uptake (peak V'O2 )...
June 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28550903/hemodynamic-effects-of-the-abdominal-aortic-and-junctional-tourniquet-in-a-hemorrhagic-swine-model
#14
Jason M Rall, James D Ross, Michael S Clemens, Jennifer M Cox, Theresea A Buckley, Jonathan J Morrison
BACKGROUND: Torso hemorrhage constitutes a leading cause of battlefield mortality. The Abdominal Aortic and Junctional Tourniquet (AAJT) uses a pneumatic bladder to compress the aorta reducing pelvic and lower extremity perfusion; however, concern exists over the risk of caval compression exacerbating hypotension after application. METHODS: Male swine (70-90 kg) were randomized into four groups of 10: presence or absence of hemorrhage and AAJT placement. After a 40% hemorrhage, a 15-min period of hypovolemia was observed before the AAJT application...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28543813/inhaled-pulmonary-vasodilator-therapy-for-management-of-right-ventricular-dysfunction-after-left-ventricular-assist-device-placement-and-cardiac-transplantation
#15
Leah A Sabato, David M Salerno, Jeremy D Moretz, Douglas L Jennings
Right ventricular failure (RVF) after cardiac transplant (CTX) or implantation of a continuous-flow left ventricular assist device (CF-LVAD) is associated with significant post-operative morbidity and mortality. A variety of modalities have been used to treat post-operative RVF, including management of volume status, intravenous inotropes and vasodilators, and right-sided mechanical support. Inhaled vasodilator agents are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature...
May 24, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28542952/compensatory-and-decompensatory-alterations-in-cardiomyocyte-ca-2-dynamics-in-hearts-with-diastolic-dysfunction-following-aortic-banding
#16
Sara Gattoni, Åsmund Treu Røe, Jan Magnus Aronsen, Ivar Sjaastad, William E Louch, Nicolas P Smith, Steven A Niederer
KEY POINTS: At the cellular level cardiac hypertrophy causes remodelling, leading to changes in ionic channel, pump and exchanger densities and kinetics. Previous studies have focused on quantifying changes in channels, pumps and exchangers without quantitatively linking these changes with emergent cellular scale functionality. Two biophysical cardiac cell models were created, parameterized and validated and are able to simulate electrophysiology and calcium dynamics in myocytes from control sham operated rats and aortic-banded rats exhibiting diastolic dysfunction...
June 15, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28534558/-proposing-a-physiological-model-for-emergency-department-operating-principles-classification-of-overcrowding-and-guidelines-for-redesign
#17
M Herrera Carranza, F Aguado Correa, N Padilla Garrido, F López Camacho
The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants...
April 30, 2017: Anales del Sistema Sanitario de Navarra
https://www.readbyqxmd.com/read/28533915/mechanisms-of-ecg-signs-in-chronic-obstructive-pulmonary-disease
#18
Marte Strømsnes Larssen, Kjetil Steine, Janne Mykland Hilde, Ingunn Skjørten, Christian Hodnesdal, Knut Liestøl, Knut Gjesdal
OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) often have abnormal ECGs. Our aim was to separate the effects on ECG by airway obstruction, emphysema and right ventricular (RV) afterload in patients with COPD. METHODS: A cross-sectional study was performed on 101 patients with COPD without left heart disease and 32 healthy age-matched controls. Body mass index (BMI) was measured, and pulmonary function tests, ECG, echocardiography and right heart catheterisation (only patients) were performed...
2017: Open Heart
https://www.readbyqxmd.com/read/28533073/the-impact-of-sevoflurane-on-coupling-of-the-left-ventricular-to-systemic-vasculature-in-rats-with-chronic-pulmonary-hypertension
#19
Lu Wang, Hui Luo, Gang Qin, Yanan Cao, Xiaowei Gao, Zhong Zhang, Zhi Ye, Junjie Zhang, Qulian Guo, E Wang
OBJECTIVES: The relationship between left ventricular function and afterload has not been investigated as much as the right ventricular function under chronic pulmonary hypertension (PH) during anesthesia. This study was designed to investigate effects of sevoflurane on the intrinsic coupling relationship between the left ventricle and systemic vasculature in the presence of PH. DESIGN: A randomized, controlled study. SETTING: University hospital...
February 13, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28506541/mitral-regurgitation-grading-in-the-operating-room-a-systematic-review-and-meta-analysis-comparing-preoperative-and-intraoperative-assessments-during-cardiac-surgery
#20
Filippo Sanfilippo, Christopher Johnson, Diego Bellavia, Marco Morsolini, Giuseppe Romano, Cristina Santonocito, Luigi Centineo, Federico Pastore, Michele Pilato, Antonio Arcadipane
OBJECTIVE: To assess differences in mitral regurgitation (MR) grade between the preoperative and the intraoperative evaluations. DESIGN: Systematic review and meta-analysis of 6 observational studies found from MEDLINE and EMBASE. SETTING: Cardiac surgery. PARTICIPANTS: One hundred thirty-seven patients. INTERVENTION: Comparison between the preoperative MR assessment and the intraoperative evaluation conducted under general anesthesia (GA), with or without "hemodynamic matching" (HM) (artificial increase of afterload)...
February 13, 2017: Journal of Cardiothoracic and Vascular Anesthesia
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